Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias / 亚洲男科学杂志(英文版)

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).

Preoperative Factors Affecting the Outcome of Single Stage Hypospadias Repair- An Observational Study

Background:Hypospadias is one of the commonest congenital anomaly in boys which requires either a single stage repair or staged repair. The success of the procedure depend upon the type, anatomy, experience of the surgeon, method of repair and preoperative hormonal stimulation. Aim: The aim of the study was to evaluate the various preoperative factors responsible for outcome of single stage repair in distal penile, mid penile and proximal penile hypospadias. Methods: There were 48 patients in this observational study which were divided into two groups. Group A comprised of 24 patients with glanular and coronal hypospadias while Group B comprised of 16 patients with distal penile, 5 mid penile and 3 proximal penile types with minimal chordae. All the 24 (50%) patients in group A underwent meatal advancement and glanuloplasty incorporated (MAGPI) repair while in group B 15 (31.25%) patients underwent Tabularized Incised Plate (TIP) repair and 9 (18.75%) patients underwent combined TIP and Mathieu抯 repair. Results: Overall operative success rate observed in the study was 41 (85.41%) patients. In 7 (14.58%) patients urethrocutaneous fistula as a major complication occurred which included 1 patient in Group A and 2 patients with Distal Penile Hypospadias (DPH), 2 patients with Mid Penile Hypospadias (MPH) and 2 patients with Proximal Penile Hypospadias (PPH) in Group B. In 2 (4.16%) patients, mild meatal stenosis was noted which settled with meatal dilatation. Urethrocutaneous fistula (UCF) disappeared in 2 (4.16%) patients on follow up with regular urethral dilatation. Conclusion: MAGPI is the ideal procedure for glanular/coronal hypospadias. For distal penile hypospadias, TIP alone or combined TIP and Mathieu抯 repair gives equally good results. Preoperative testosterone therapy reduces the incidence of complications in a single stage hypospadias repair.

Tunica vaginalis flap – is it a better surgical choice for urethro-cutaneous fistula following circumcision?

Objective: To study the effectiveness of tunica vaginalis flap in repair of post circumcision urethro- cutaneous fistula. Materials and Methods: The current study reviewed all patients having surgical repair of post-circumcision urethrocutaneous fistula from December 2014 to April 2019 at our institution. Results: Ten cases presenting at age 5 to 22 years were operated. Most [60%] of the circumcisions were performed by a doctor at peripheral hospitals and others were done by traditional circumcisers. All cases had a single fistula and the size was more than 5mm in all cases. Three-layered fistula closure was done in all cases using the tunica vaginalis flap as the second layer for closure. There was no recurrence in any case. Conclusion: Use of Tunica vaginalis flap for repair of post circumcision urethro-cutaneous fistula is a highly effective technique regardless of size and site of the fistula. It is a simple procedure without any postoperative complications and without any recurrence

The application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair / 中华泌尿外科杂志

Objective To investigate the application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair.Methods Retrospective analysis was performed in 45 redo hypospadias repair cases,aged from 1 year 3 months to 9 years 4 months (median 5 years 3month).All patients were divided into urethral dehiscence after hypospadias repair (group A) and the second stage surgery of two-stage hypospadias repair (group B) based on medical history.According to the site of dehiscence,the group A were further divided into midshaft urethral dehiscence (A1) and glans and distal urethral dehiscence with urethral opening located on midshaft (A2).After new urethra was completed,the appropriate size of the pedicledtunica vaginalis flap was transferred to cover the new urethra.Results There was no scrotal hematoma occurred in all 45 cases,and somecomplications occurred,including scrotal swelling in 1 case,high-riding testicle in 2 cases,penile clockwise torsion in 1 case,urethrocutaneous fistula in 6 cases.All the 45 cases were followed up for 1 to 4 years,with mean of 1.8 years.One more urethrocutaneous fistula occurred in group A2 and 1 more urethrocutaneous fistula with urethral stricture occurred in group B.There was no penile curvature and urethral diverticulum occurred in all cases.Conclusions Pedicled tunica vaginalis flap could be used as waterproofing layer to cover new urethra in redo hypospadias repair and presented a low incidence rate of postoperative complications.

The individual therapy of urethrocutaneous fistula after primary urethroplasty for hypospadias / 中华泌尿外科杂志

Objective To investigate the proper procedure for repairing different urethrocutaneous fistulas after primary urethroplasty for hypospadias.Method There were 101 cases,whose age ranged from 27 months to 171 months (mean 61 months),underwent urethrocutaneous fistula repairing secondary to the primary hypospadiasis urethroplasty from January 2010 to December 2015.The methods of the repairing were chosen mainly on the site and the size of the fistula,which included three types.The coronal fistula with a thin band of tissue stretching between the glans wings was classified as type Ⅰ (n =24).For the rest of the small fistulas at penis coronal ditch and penis body,the small fistula (diameter ＜ 3 mm) was classified as type Ⅱ (n =57) and the large fistula (diameter ≥3 mm) was classified as type Ⅲ(n =30).The urethroplasty was performed in the type Ⅰ cases.The ligation and transfixion was performed in type lⅡ cases.And the tension free repairing with continuous suture was performed in type Ⅲ cases.De-epithelization dartos fascia flap or tunica vaginalis flap covering was performed in all cases.After removing the catheter,all cases were followed-up at least 1 year.The successive operation was termed as no complication,such as urethral stricture,urethral diverticulum and urethrocutaneous fistula.Result Totally 111 fistulas were repaired by the methods described above.The mean followed-up duration was 32 months (ranging 12-48months).Total recurrence of fistula was 11.7％ (13/111) in different type fistulas,including 16.7％(4/24) in type Ⅰ,3.5％ (2/57) in type Ⅱ and 23.3％ (7/30) in type 1Ⅲ.Conclusions Different classification and treatment of urethrocutaneous fistula after urethroplasty by the site and size of fistula can improve the outcome of the operation.It is necessary to cover the tissue tightly to a new urethra during the operation.

The individual therapy of urethrocutaneous fistula after primary urethroplasty for hypospadias / 中华泌尿外科杂志

Objective To investigate the proper procedure for repairing different urethrocutaneous fistulas after primary urethroplasty for hypospadias.Method There were 101 cases,whose age ranged from 27 months to 171 months (mean 61 months),underwent urethrocutaneous fistula repairing secondary to the primary hypospadiasis urethroplasty from January 2010 to December 2015.The methods of the repairing were chosen mainly on the site and the size of the fistula,which included three types.The coronal fistula with a thin band of tissue stretching between the glans wings was classified as type Ⅰ (n =24).For the rest of the small fistulas at penis coronal ditch and penis body,the small fistula (diameter ＜ 3 mm) was classified as type Ⅱ (n =57) and the large fistula (diameter ≥3 mm) was classified as type Ⅲ(n =30).The urethroplasty was performed in the type Ⅰ cases.The ligation and transfixion was performed in type lⅡ cases.And the tension free repairing with continuous suture was performed in type Ⅲ cases.De-epithelization dartos fascia flap or tunica vaginalis flap covering was performed in all cases.After removing the catheter,all cases were followed-up at least 1 year.The successive operation was termed as no complication,such as urethral stricture,urethral diverticulum and urethrocutaneous fistula.Result Totally 111 fistulas were repaired by the methods described above.The mean followed-up duration was 32 months (ranging 12-48months).Total recurrence of fistula was 11.7％ (13/111) in different type fistulas,including 16.7％(4/24) in type Ⅰ,3.5％ (2/57) in type Ⅱ and 23.3％ (7/30) in type 1Ⅲ.Conclusions Different classification and treatment of urethrocutaneous fistula after urethroplasty by the site and size of fistula can improve the outcome of the operation.It is necessary to cover the tissue tightly to a new urethra during the operation.

Application of vascularized tunica vaginalis flap technique in repairing recurrent urethrocutaneous fistula following hypospadias surgery / 中华泌尿外科杂志

Objective To investigate the feasibility and efficacy of tunica vaginalis flap cover in treatment of recurrent urethrocutaneous fistula (UCF).Methods We reviewed the clinical datas of 25 cases of UCF after urethroplasty of hypospadias from January 2011 to January 2015.The mean age of the patients was 6.2 years(range 1.6-14.0 years).All patients had undergone previous hypospadias repair and at least one previous failed attempt to close the urethrocutaneous fistulae.There were 5 cases of fistula in the coronary sulcus,6 cases of fistula in the penile body and 14 cases of fistula at the junction of penis and scrotum.The diameter of urethrocutaneous fistulae were 3-10 mm.Single fistula was present in all patients.16 cases had undergone UCF repair for two times, 9 cases had undergone UCF repair for more than two times.After closing the fistula with inverting running stitch, a tunica vaginalis flap was mobilized to cover the repair site through a subcutaneous tunnel and the skin closed.Results The mean follow-up time was 2.1 years(range 0.5-4 years).The overall success rate was 96％ (24/25).Penile cosmesis was excellent.There was no evidence of recurrent fistulas or urethral strictures.All parents reported a straight penis when erected, and one patient in whom there was leak from the fistula site because of local wound infection.No postoperative complication was encountered in the testis.The testis was of normal size and position, and the ultrasound findings were normal.Conclusions Repairment of recurrent urethrocutaneous fistulas with a tunica vaginalis flap could be effective regardless of fistula location.The technique is simple to improve the success rate of the repair of UCF effectively and reduce the occurrence of postoperative complications.

Giant urethral calculus associated with urethrocutaneous fistula: a case report.

Urethral stones in men are rare clinical entity and most of them migrate from urinary bladder. Giant urethral calculi are extremely rare. This report describes the case of 62 year male patient presenting with giant bulbar urethral calculus associated with urethrocutaneous fistula.

Congenital Urethrocutaneous Fistula: An Interesting Case

A congenital urethrocutaneous fistula is a rare anomaly which was first described in 1962 by Gupta. Clinically, children present when their guardian is alarmed by either frequent urinary dribbling or unusual stream when they pass urine. This congenital anomaly can present in isolation or be accompanied by a chordee, hypospadia and anorectal malformations in a newborn. The surgical management will either be a primary repair of the fistula or converting it to a hypospadia before proceeding with a single or staged hypospadia repair. Surgical technique will depend on the local tissue factors and associated anomalies.

Analysis of therapeutic methods of surgical treatment for urethrocutaneous fistulas after urethroplasty / 中华泌尿外科杂志

Objective To discuss the curative effect of different operative methods for the treatment of urethrocutaneous fistula (UCF) after urethroplasty.Methods Clinical data of 54 cases of UCF from January 2003 to July 2011 were collected.Simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were performed according to the size,location,number and whether there was urethral stricture of UCF.The treatment effect was recored and analyzed.Results The success rate of UCF repair was 85％ (46/54).There were 4 patients cured after second surgery.The success rates of repair of UCF with simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were 95％,76％,82％,and 83％,respectively.Postoperative recurrence was observed in 5 patients in 6 months after the surgery and 4 of them received the re-operation.Conclusion According to the principle and the individual circumstance,taking personalized operative methods may improve the success rate of the repair of all kinds of UCF.

Male Urethral Diverticulum Combined with Stone and Urethrocutaneous Fistula / 대한비뇨기과학회지

A male urethral diverticulum is a relatively uncommon abnormality. It usually occurs at the penoscrotal junction and most of these lesions develop as secondary disorder after a urethral trauma, obstruction or infection. Here we report a case of a male urethral diverticulum combined with a stone and a urethrocutaneous fistula.

Male Urethral Diverticulum Combined with Stone and Urethrocutaneous Fistula / 대한비뇨기과학회지

A male urethral diverticulum is a relatively uncommon abnormality. It usually occurs at the penoscrotal junction and most of these lesions develop as secondary disorder after a urethral trauma, obstruction or infection. Here we report a case of a male urethral diverticulum combined with a stone and a urethrocutaneous fistula.

Microsurgical management of urethral fistula occurred after urethroplasty in hypospadias / 中华显微外科杂志

Objective To evaluate the role of mierosurgery in surgical treatment to urethrocutaneous fistula after urethroplasty in hypospadias and improve surgical results.Methods From 1999 to 2006,44 urethrocutaneous fistulae (more than 3mm in diameter) after urethroplasty for hypospadias in 33 patients were repaired with different skin flaps.For example,Thiersch technique,urthroplasty,etc.Microsurgical tech- nique was employed in every case.Results The success rates of different procedure were 84.8% (28/33) for Thiersch technique,100% (11/11) for urethroplasty respectively.The total success rate was 88.6%(39/ 44).Conclusion It's just application of skin flap for repairing of big or complex urinary fistula after hypos- padias surgery.The application of microsurgical technique can increase success rate.It is necessary to excise scar and partial urethra for hypospadias fistula combined with urethral structures,cicatricial eontracture and in- curvation of penis.Rich blood-supply,low tension and atraumatic technique are all very important to improve surgery success rates of urinary,fistula after hypospadias repair.

A Case of Congenital Urethrocutaneous Fistula / 대한비뇨기과학회지

We report a congenital urethrocutaneous fistula in 13 months old male. The congenital urethrocutaneous fistula is a rare anomaly. The cause of congenital urethrocutaneous fistula is unknown but probably involves a focal defect in the urethral plate that prevents fusion of the urethral fold. He is now being followed up without any evidence of voiding problems after the defects was covered with penile skin flap.

Subcutaneous Tissue Coverage to Prevent Urethrocutaneous Fistula in Hypos- padias Repair / 대한비뇨기과학회지

Urethrocutaneous fistula is the most common complication of hypospadias surgery, Many techniques have been tried to prevent urethrocutaneous fistula. We introduce the technique of neourethral coverage using adjacent subcutaneous tissue or a dorsal pedicled subcutaneous flap in hypospadias repair. This method was used in a series of 25 cases between April 1996 and April 1997. We experienced only one urethrocutaneous fistula. The additional coverage of the neourethra with the subcutaneous tissue achieves the goal of non-overlapping suture lines and allows for increased vascularity. So, this technique appears to be effective in preventing urethrocutaneous fistula in hypospadias repair.

The Repair of Urethrocutaneous Fistula Occurring after Hypospadias Repair / 대한비뇨기과학회지

No Abstract available.

Management of Urethrocutaneous Fistulas Following Hypospadias Repair / 대한비뇨기과학회지

Urethrocutaneous fistulas are one of the major causes of morbidity following hypospadias repair. It is desirable to design and execute urethral surgery so that primary and complete healing occurs. But from a practical point of view, it will probably be impossible to achieve that goal. So, any surgeon performing hypospadias repair must be prepared to manage the fistulas. In this article, we reviewed 25 patients with urethrocutaneous fistulas following hypospadias repair. In l8 patients the purse-string suture with subcutaneous running sutures was applied. The initial success rate was 77.8%(14/18) and total success rate was 94.4% (17/18) after 2nd operation.

Deepithelialized Scrotal Skin Flap in Repair of Urethrocutaneous Fistula and Urethroplasty / 대한비뇨기과학회지

Eight patients undergoing closure of urethrocutaneous fistula and 15 patients undergoing urethroplasty for hypospadias were reviewed. Most of fistulas were presented in the penoscrotal level. Fistulas were closed using a deepithelialized scrotal skin flap. Of 8 patients with fistulas were repaired by this method there were no recurrences and 3 were performed without urinary diversion or urethral stenting. Of l5 patients with hypospadias undergoing urethroplasty using a deepithelialized scrotal flap there were no fistulas in the original urethral opening area but a fistula distal to the original urethral opening was found in 3 patients This technique is very satisfactory in repair of the complicated as well as the simple urethrocutaneous fistulas which can be done without urinary diversion or urethral stenting and seems to be useful in reducing fistula formation following urethroplasty in hypospadias.